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COVID-19: What happens when a pandemic becomes endemic?

COVID-19: What happens when a pandemic becomes endemic?

Pedestrians wearing protective face masks along Singapore's Central Business District. (File Photo: Calvin Oh)

SINGAPORE: In a televised address on Monday (May 31), Prime Minister Lee Hsien Loong said he believed COVID-19 would not disappear, but instead “remain with humankind and become endemic”.

The virus would continue to circulate in parts of the global population for years to come, with “small outbreaks” of the disease from time to time in Singapore, said Mr Lee.  

“Our aim must be to keep the community as a whole safe, while accepting that some people may get infected every now and then - just as we do with the common flu or dengue fever, which we now manage through public health measures and personal precautions, and in the case of the flu, with regular vaccinations too,” he added. 

Last week, Finance Minister Lawrence Wong - co-chair of the multi-ministry taskforce tackling the pandemic - said that Singapore was already planning for the possibility that COVID-19 might become endemic

But what would it mean for COVID-19 to become endemic?

READ: Singapore 'on track' to bring COVID-19 outbreak under control; curbs may be eased after Jun 13: PM Lee


The term endemic refers to diseases that are constantly present within a population, with infection rates maintained at a predictable rate.

Mr Lee made a comparison to dengue fever, which he noted was managed through “public health measures and personal precautions”. 

There is precedent for epidemics to eventually become endemic, said Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, who pointed to several examples. 

“It happened most recently with H1N1 Influenza A 2009, which became endemic within a year-and-a-half,” he said, pointing also to other instances in 1957 and 1968. 

COVID-19 could become “just like one of the ‘common cold’ coronaviruses”, said Prof Tambyah, with the elderly being the main concern. 

“That is what many people believe happened with OC43, one of today’s common cold coronaviruses which is believed to have caused the ‘Russian Flu’ pandemic of the late 19th century,” he said. 

READ: What could prolong the COVID-19 pandemic? Experts list the risks and unknowns ahead

Becoming endemic means COVID-19 is not going to “go away”, said Professor Dale Fisher, who chairs the World Health Organization’s Global Outbreak Alert and Response Network. 

“It's not going to be eradicated, it's going to be here.  But for practical purposes, the only people that will go to hospital are (unvaccinated) people,” said Prof Fisher, who is also a senior infectious diseases consultant at the National University Hospital.

COVID-19 could circulate and mutate in ways similar to influenza, he said, noting that in temperate climates it could become a seasonal disease. 

However, Prof Fisher stressed that this does not mean that sceptics who said that COVID-19 was no worse than the flu were correct. 

“Anyone that's thought COVID is like the flu, I think they were proven to be wrong in many ways, not least of which is the severity (of COVID-19),” he said.

While most of those who contracted the disease only experienced mild symptoms, millions have died, he pointed out. 

More than 3.5 million people have died from COVID-19 since the pandemic began last year, compared to the estimated 290,000 to 650,000 who die from influenza annually. 

The availability of vaccines has proven to be a turning point for the pandemic, turning COVID-19 into a “mild disease”, said Prof Fisher. 

This means some of the regulations now in place to stem the spread of COVID-19, such as border restrictions and safe management measures, could be eased as more people get vaccinated, he added. 

Dr Leong Hoe Nam, an infectious diseases specialist with the Rophi Clinic at Mount Elizabeth Novena Hospital, said vaccination is an “integral strategy” in living with an endemic virus. 

Those who have already received both jabs of the COVID-19 vaccine should be prepared for a third shot to boost their immunity, while others could expect to have regular annual doses of the vaccine similar to flu shots, he wrote in a commentary for CNA

READ: Commentary: We have to live with an endemic COVID-19. Here's what that could look like


Prof Fisher emphasised that it is not yet time to relax measures - such as contact tracing and testing for COVID-19 - which he stressed are necessary for Singapore to get to the “end point”. 

“If we take our foot off the brakes now, then we are going to have an explosive situation,” he said, noting less than 40 per cent of Singapore’s population have had at least one jab of the COVID-19 vaccine. 

It is hard to say when COVID-19 might become endemic globally, said Prof Tambyah, though he noted that one estimate suggests it might take three or four years.

“Endemic living will happen in Singapore when we achieve a high vaccination rate of about 70 to 90 per cent of the population and when unlinked cases do not overwhelm our contact tracing capabilities,” said Dr Leong. 

READ: Commentary: COVID-19 unlikely to become a thing of the past anytime soon

“Care of COVID-19 patients will improve with better medical technologies, and perhaps oral antiviral treatments and highly effective, broadly neutralising, monoclonal antibodies that can kill the virus,” he added.  

Still, COVID-19 becoming endemic does not rule out the possibility of future pandemics, experts say.  

“As long as we continue to encroach onto the territory of wild animals and do all kinds of experiments in diverse laboratories, there is always a risk of another coronavirus breakout,” said Prof Tambyah.

There is a “very high chance” of a novel influenza pandemic in the next few years, he added. 

“There has not been very much influenza worldwide and in fact, the last case of influenza detected by surveillance in Singapore was more than a year ago,” he said, describing influenza as “promiscuous” and able to live in a variety of animals ranging from ducks to seals. 

“I don't think we bought a breather, nature does what it does,” said Prof Fisher. 

“Could there be a new strain of flu that is (similar to COVID-19) next year? That's possible.”

Source: CNA/az